Globalization discourse, and its promises of a 'flat world', 'borderless economy' and 'mobility of ideas and people', has become very widespread in all fields. In medical education this discourse is underpinned by assumptions that medical competence has universal elements and that medical education can therefore develop 'global standards' for accreditation, curricula and examinations. Yet writers in the field other than medicine have raised a number of concerns about an overemphasis on the economic aspects of globalization. This article explores the notion that it is time to study and embrace differences and discontinuities in goals, practices and values that underpin medical competence in different countries and to critically examine the promises-realized or broken-of globalization discourse in medical education.